Complete the online Disability Benefit Application.
After you fill out the application, you will be asked to confirm the truthfulness of your answers under penalty of perjury and your response will be recorded. You can be held liable by law for providing false or misleading information.
"Sign" the application electronically by clicking on the "Submit Now" button that will appear on the screen after you have finished filling out the application.
The only person who can "sign" the application is the person who is applying for benefits. A legal representative or person who is helping cannot sign the application.
Complete an Adult Disability Report online after you finish this application.
You can also call to make an appointment to have one of our representatives help you.
Your date and place of birth and Social Security number;
Your bank or other financial institution's Routing
Transit Number and the account number [more info], if you want the benefits electronically deposited.
The beginning and ending dates of any active U.S. military service you had before 1968; and
The name, Social Security number and date of birth or age of your current spouse and any former spouse. You should also know the dates and places of marriage and dates of divorce or death (if appropriate).
Even if you do not have a record of your earnings or you are not sure if they are correct, please fill out the application. We will help you review and correct the earnings history when we receive the application.
Information about medical evidence already in your possession. This includes medical records, doctors' reports, and recent test results;
Detailed information about your medical illnesses, injuries or conditions and your work history; and
Information about any workers' compensation, black lung, and/or similar benefits you filed, or intend to file for. These benefits can:
Be temporary or permanent in nature;
Include annuities and lump sum payments that you received in the past;
Be paid by your employer or your employer's insurance carrier, private agencies, or Federal, State or other government or public agencies;
Be referred to as:
Black Lung Benefits,
Longshore and Harbor Workers' Compensation,
Civil Service (Disability) Retirement,
Federal Employees' Retirement,
Federal Employees' Compensation,
State or local government disability insurance benefits,
Disability benefits from the military (This includes military retirement pensions based on disability but not Veterans' Administration (VA) benefits).
Documents You May Need to Provide
We may need to see certain documents in order to pay benefits. A list of these documents will appear at the end of the application, along with instructions on where to submit them. The types of documents we may ask for are:
proof of U.S. citizenship or lawful alien status if you were not born in the United States [more info];
a copy of your U.S. military service paper(s) (e.g., DD-214 - Certificate of Release or Discharge from Active Duty) [more info]; and
a copy of your W-2
form(s) [more info] and/or self-employment
tax return [more info] for last year.
Note: If our records show that documents proving age or citizenship/lawful alien status have already been submitted for an earlier Medicare or Social Security claim (e.g., Disability, Supplemental Security Income, etc.), you do not need to submit the documents again.
We will return all documents and photocopies unless specifically told otherwise.
Medical Evidence You May Need to Provide
You will need to provide medical evidence [more info] already
in your possession regarding your disability. This includes copies or photocopies of medical records, doctors' reports, and recent test results.
You will also need to provide the following:
an Adult Disability Report that collects more details about your illnesses, injuries or conditions, and your work history.
At the end of the application, we will give you a link to another Social Security web page where you can fill out the Adult Disability Report online.
Award letters, pay stubs, settlement agreements or other proof of temporary or permanent workers' compensation-type benefits you received. We will need documents that show:
the date of your injury or illness;
the amount and effective date of your current payment and
all increases or decreases within the last 17 months or, if later, since payments began;
if you receive workers' compensation [more info], the type of payment (e.g., temporary partial, temporary total, permanent partial, permanent total, a lump sum or an annuity);
the frequency of your payments (e.g., weekly, bi-weekly, monthly, bi-monthly, etc.) or the period covered by a lump sum;
if benefits have already ended, the last day you were entitled to a payment and your last payment amount (if different than your regular payment amount);
your employer's name, address and phone number; and
if an insurance carrier makes the payments instead of the employer, we need their name, address and phone number.
We will return all documents and photocopies unless specifically told otherwise
Even if you don't have all the documents we need, you should still submit the application and any documents you do have. You can provide the missing documents later or we may be able to help you get them.
If you delay submitting the application, you could lose some benefits you may be due.
If you mail any documents to us, you must include the Social Security number so that we can match them with the correct application. Do not write anything on the original documents. Please write the Social Security number on a separate sheet of paper and include it in the mailing envelope along with the documents. If you do not want to mail these documents, you may bring them to a Social Security office.
Do not mail foreign birth records or any documents from the Department of Homeland Security (DHS), formerly the Immigration and Naturalization Service (INS), especially those you (the claimant) are required to keep with you at all times. These documents are extremely difficult, time-consuming and expensive to replace if lost. Some cannot be replaced. Instead, bring them to a Social Security office where they will be examined and returned.